Avoiding Hospital Admission A Game of Snakes and Ladders! ACHSE 19 June 2007 Stephen Wilson Program Director Population Health.

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Presentation transcript:

Avoiding Hospital Admission A Game of Snakes and Ladders! ACHSE 19 June 2007 Stephen Wilson Program Director Population Health

RESPONSE MANAGEMENT PREVENTION/ EDUCATION/ REHABILITATION Patients: 1000’s 100’s 10’s Disease Treatment Hospital

RESPONSE MANAGEMENT PREVENTION/ EDUCATION/ REHABILITATION Patients: 1000’s 100’s 10’s Disease Treatment Hospital

RESPONSE MANAGEMENT PREVENTION/ EDUCATION/ REHABILITATION Patients: 1000’s 100’s 10’s Disease Treatment Hospital

RESPONSE MANAGEMENT PREVENTION/ EDUCATION/ REHABILITATION Patients: 1000’s 100’s 10’s Wilson S, Mc George P.“Health Sandwich” MJA 2006

TRIGGER DIAGNOSTIC LADDER TREATMENT LADDER PATIENT JOURNEY

TRIGGER SELF MANAGE DIAGNOSTIC LADDER TREATMENT LADDER PATIENT JOURNEY

TRIGGER SELF MANAGE AHP,RN or Pharmacy DIAGNOSTIC LADDER TREATMENT LADDER PATIENT JOURNEY

TRIGGER SELF MANAGE AHP,RN or Pharmacy GP DIAGNOSTIC LADDER TREATMENT LADDER PATIENT JOURNEY

TRIGGER SELF MANAGE AHP,RN or Pharmacy GP ED DIAGNOSTIC LADDER TREATMENT LADDER PATIENT JOURNEY

TRIGGER SELF MANAGE AHP,RN or Pharmacy GP ED Hospital Bed DIAGNOSTIC LADDER TREATMENT LADDER PATIENT JOURNEY

TRIGGER SELF MANAGE AHP,RN or Pharmacy GP ED CAPAC Hospital Bed DIAGNOSTIC LADDER TREATMENT LADDER PATIENT JOURNEY

TRIGGER SELF MANAGE AHP,RN or Pharmacy GP ED CAPAC RN, AHP or Pharmacy Hospital Bed DIAGNOSTIC LADDER TREATMENT LADDER PATIENT JOURNEY

TRIGGER SELF MANAGE AHP,RN or Pharmacy GP ED CAPAC RN, AHP or Pharmacy Personal Care provider Hospital Bed DIAGNOSTIC LADDER TREATMENT LADDER PATIENT JOURNEY

TRIGGER MAINTENANCE SELF MANAGE AHP,RN or Pharmacy GP ED CAPAC RN, AHP or Pharmacy Personal Care provider Hospital Bed DIAGNOSTIC LADDER TREATMENT LADDER PATIENT JOURNEY

TRIGGER MAINTENANCE SELF MANAGE AHP,RN or Pharmacy GP ED CAPAC RN, AHP or Pharmacy Personal Care provider Hospital Bed DIAGNOSTIC LADDER TREATMENT LADDER ALTERNATIVE PATIENT JOURNEY ED Bypass

TRIGGER MAINTENANCE SELF MANAGE AHP,RN or Pharmacy GP ED CAPAC RN, AHP or Pharmacy Personal Care provider Hospital Bed DIAGNOSTIC LADDER TREATMENT LADDER ALTERNATIVE PATIENT JOURNEY Hospital Bypass

TRIGGER MAINTENANCE SELF MANAGE AHP,RN or Pharmacy GP ED CAPAC RN, AHP or Pharmacy Personal Care provider Hospital Bed DIAGNOSTIC LADDER TREATMENT LADDER ALTERNATIVE PATIENT JOURNEY Assisted Self Management

TRIGGER MAINTENANCE SELF MANAGE AHP,RN or Pharmacy GP ED CAPAC RN, AHP or Pharmacy Personal Care provider Hospital Bed DIAGNOSTIC LADDER TREATMENT LADDER PATIENT JOURNEY

Acute on Chronic Flu Vac CDSM Multi Dis Review GPHMR EPC Plan CAPAC Personal Care Game over Restructure Health Service ED ICU MRSA Drug Interaction DVA Gold card confused Ambulatory Assess Ward Incontinent Bogus whistle Blower Pulmonary rehab ACAT Copyright S.Wilson